Managing Cancer-Related

Pain
A Guide for Patients, Families, and Caregivers from
the American Society of Clinical Oncology
ABOUT ASCO
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resents nearly 45,000 oncology professionals who care for people living wizth cancer. Through
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MANAGING
CANCER-RELATED PAIN
Introduction 2 Other Ways to Manage Pain 17
Understanding Cancer-Related Pain 3 Self-care methods 17
The importance of pain relief 4 Support methods 19
Causes of pain 5 Communicating With Your
Health Care Team 21
Diagnosing pain 6
How pain tracking helps 22
Types of pain-relief strategies 7
Resources 23
Managing Pain With Medication 9
Dictionary 24
Types of pain medication 9
Sample Pain Tracker 26
Common concerns about
pain medication 11
Taking pain medication correctly 12
Managing multiple prescriptions 14
Storing and disposing of
medications 15

ASCO ANSWERS is a collection of oncologist-approved patient education materials developed by ASCO for
people with cancer and their caregivers.
This booklet was developed by and is ©2020 American Society of Clinical Oncology, Inc. (ASCO). All rights
reserved worldwide. No sponsor was involved in the development of the content. The mention of any company,
product, service, or therapy does not constitute an endorsement of any kind by ASCO or Conquer Cancer®,
the ASCO Foundation. It is the responsibility of the treating physician or other health care provider, relying on
independent experience and knowledge of the patient, to determine drug dosages and the best treatment for
the patient. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or
related to any use of the booklet or any errors or omissions. Information in ASCO’s patient education materials is
not intended as medical advice or as a substitute for medical advice. Patients with health care-related questions
should call or see their physician or other health care provider promptly and should not disregard professional
medical advice, or delay seeking it, because of information encountered here. ASCO believes that all treatment
decisions should be made between patients and their doctors. Advances in the diagnosis, treatment, and
prevention of cancer occur regularly. For more information, visit Cancer.Net.

MANAGING CANCER-RELATED PAIN 1

INTRODUCTION
Many people with cancer experience pain during or after treatment. But nearly all
cancer-related pain can be managed successfully for most people. Relieving pain—with or
without medication—is an important part of overall cancer care.

Just as no two cancers are alike, each patient’s experience with pain is different. The goal is
to find pain-relief solutions that are acceptable to the patient and the health care provider
and that allow for the best possible quality of life. Pain management is most effective when
it starts as soon as possible. It should continue through all phases of treatment and into
follow-up care.

This booklet is designed to help people diagnosed with cancer, their families, and their
caregivers understand the importance of pain relief. It includes different kinds of pain
management options and ways patients can communicate their pain clearly to their
doctors. You will also find important resources, such as a sample pain-tracking log.
With all of the pain-relief options available, there is no reason for anyone to suffer from
uncontrolled cancer-related pain. Together, you and your health care team can develop an
individualized pain management plan that can help make your diagnosis, treatment, and
follow-up care easier and more effective.

2 ASCO ANSWERS
UNDERSTANDING
CANCER-RELATED PAIN
No matter what type of
pain you experience, it is
crucial that you tell your
doctor, nurse, or another
member of your health
care team. Preventing pain
from developing or getting
worse is one of the most
effective ways to manage
it. Your health care team’s
role in managing pain is to
listen to your concerns and
offer safe solutions. This
approach is called palliative
care or supportive care.

Some people do not want to tell their doctor they are experiencing pain. They may think
the pain means that the cancer has worsened or spread. Others feel like pain is simply a
part of living with cancer and that they should not complain. Although these thoughts
are understandable, there are many reasons pain occurs—and you do not need to suffer
from it.

You can play an active role in managing your pain by:

` Being open with your health care team about your pain
` Sharing any concerns you have about pain-relief options with the team
` Letting the team know if your pain gets better or worse
` Following the suggested treatment plan

Remember, every patient has the right to live with as little pain as possible.

More information about pain and other side effects can be found at
www.cancer.net/pain.

MANAGING CANCER-RELATED PAIN 3

The importance of pain relief
It can be difficult to talk about pain. It can be hard to find words to describe unpleasant or
overpowering feelings and sensations. But there are several important reasons to tell your
health care providers about any pain you have.

In most cases, your health care providers can likely relieve your pain. Finding a solution
can help you remain active, sleep better, and improve your appetite. It will also help you
enjoy activities and time spent with family and friends.

Pain can make other symptoms or side effects of cancer seem worse or cause
new ones. Managing your pain can help you avoid experiencing unnecessary fatigue,
depression, anger, worry, or stress.

The pain might tell your health care team something about how the cancer treatment
is working. The pain could be a signal that tells your health care providers how to adjust or
change your care to make it more effective.

To find the best pain-relief strategies, you need to share your symptoms with your health
care team. Also, consider sharing any concerns you may have about the different types
of pain-relief strategies available. For example, some people may worry that a specific
medicine is addictive or will make them sleepy or groggy. Your health care providers can
help you find a pain-relief plan that works for you. That plan might include other methods
of pain relief in addition to or in place of medication.

RUDY’S STORY
Rudy, a grandfather of 10, was diagnosed with prostate cancer the year he turned
65. Rudy was not sure if he should tell his doctor or nurse about the pain caused
by his treatment. He thought it was a normal side effect and doubted that they
could do anything about it. But, the holidays were coming and he wanted to
travel to his daughter’s house. He did not want his family to see him suffering.
He also did not know if he could withstand the long drive. When Rudy realized
the pain was affecting his quality of life, he decided to talk with his health care
team. His doctor did an evaluation of his pain, called a pain assessment, and then
offered several strategies to try to control it. Rudy found relief by wearing a patch
on his skin that delivered pain medication. He also found relief through physical
therapy, an approach he had not considered until his doctor suggested it. Rudy
was thankful that he was able to spend the holidays with his loved ones.

4 ASCO ANSWERS
Causes of pain
There are different types of cancer pain.
Pain may last just a short time and be
triggered by a procedure, treatment,
a certain position, or movement. Pain
may only occur from time to time. Or,
pain may be long-lasting and constant.
Pain may also increase suddenly even
though it is being treated. This is called
“breakthrough pain.” Breakthrough pain
typically occurs between scheduled doses
of pain medicine. It is not always linked to
a specific movement or time of day.

A good pain management plan will help relieve pain, no matter what causes it, including:

The tumor. A tumor growing in an organ, such as the liver, may stretch part of the organ.
This stretching can cause pain. If a tumor grows and spreads to the bones or other organs, it
may put pressure on nerves and damage them, causing pain. Or if a tumor spreads or grows
around the spinal cord, it can compress the spinal cord. This eventually leads to severe pain
or paralysis if not treated.

Surgery. It is normal to experience pain from cancer surgery. Most pain goes away after a
while. But some people may have pain that lasts for months or years. This long-lasting pain
can be from permanent damage to the nerves and the development of scar tissue.

Radiation therapy. Pain may develop after radiation therapy, and it may or may not go
away on its own. It can also develop months or years after treatment, especially after
radiation therapy to some parts of the body, such as the chest or spinal cord.

Chemotherapy. Some chemotherapy can cause pain and numbness in the fingers and
toes, called peripheral neuropathy. Usually this pain goes away when treatment is finished.
But sometimes the damage is permanent.

Hormonal therapy. Hormonal therapy, or endocrine therapy, may cause muscle and bone
pain. This type of treatment can increase a person’s risk of osteoporosis and bone fractures,
which also cause pain.

Stem cell/bone marrow transplant. Transplantation may cause pain, particularly if the
patient develops a serious side effect of this treatment called graft-versus-host disease.

MANAGING CANCER-RELATED PAIN 5

Other causes. People with cancer can have pain from other causes, such as migraine
headaches, arthritis, or chronic lower-back pain. The treatment plan your health care team
develops with you should address these kinds of pain, because any pain can affect your
quality of life.

Diagnosing pain
You know your pain best. So it is important
to discuss any new symptoms or a change in
symptoms with your doctor or a pain specialist.
They can help you find a medication or other
pain-relief method that works for you.

To help your doctor better understand your

pain, he or she may ask the following questions:
` Where does it hurt?
` When does the pain start and stop?
` How long has the pain been there?
` How much pain are you having on a scale of 0 to 10?
` What does the pain feel like, in your own words? For example, is it burning, stabbing,
throbbing, or aching?
` What makes the pain better or worse?
` Is your pain affecting your ability to work, sleep, eat, do household chores, socialize, or
perform other everyday actions?

Talking about how the pain affects you is important because it puts a face on the pain. This
gives health care providers a sense of what it’s like to live with that pain.

For information on how to talk about your pain with members of the health care
team, read “Communicating With Your Health Care Team” on page 21.

6 ASCO ANSWERS
Types of pain-relief strategies
After thoroughly evaluating your pain, your doctor will work with you to develop a pain-
relief plan. This may also be called a pain management or pain treatment plan. Some
hospitals have pain specialists and palliative care specialists available. These experts focus
on treating the physical and emotional side effects of cancer. They help patients who have
pain that is hard to control.

Your health care team can treat or manage cancer-related pain in different ways:

Treat the source of the pain. For example, a tumor putting pressure on nerves can
cause pain. Removing the tumor with surgery or shrinking it with radiation therapy,
chemotherapy, steroids, or other medications could reduce or eliminate the pain.

Change the perception of pain. Some medications change how your body feels pain,
making it hurt less.

Interfere with pain signals sent to the brain. If medication does not work, your doctor
may need to refer you to a pain specialist for specialized medical procedures. These include
spinal treatments or pain medication injected into a nerve or tissue surrounding a nerve to
interfere with a pain signal.

MANAGING CANCER-RELATED PAIN 7

Different strategies take different
amounts of time to work. Some, like pain
medications, can work within a matter
of minutes to a couple of days. Other
medications, like antidepressants and
medications used to prevent seizures, may
take a couple of weeks to be effective.
Still others, such as radiation therapy or
chemotherapy, can take weeks to work.
Ask your health care providers when you
can expect relief and how long you should
expect the treatments to be effective.

JEAN’S STORY
Jean was diagnosed at age 30 with stage III invasive breast cancer. She had a
bilateral mastectomy with implant reconstruction, chemotherapy, and radiation
therapy. At age 40, her cancer came back. A small tumor formed between her skin
and implant. During treatment, she had acute pain caused by small fractures in her
ribs. Her oncologist prescribed medication to relieve the pain. After several weeks
and three separate medications, Jean still suffered.

Concerned by Jean’s continued discomfort, her doctor referred her to a pain

specialist in the palliative care unit at the center where Jean was being treated.
After reviewing Jean’s medical file and talking with her about her pain, the
specialist recommended an outpatient procedure that would be performed by
an interventional radiologist. After the procedure, Jean’s pain finally went away
and she was able to return to her normal activities. “Living with severe, ongoing
pain can be debilitating,” Jean said. “Normal, everyday activities are anything
but normal when you feel constant discomfort. Thankfully, I was able to put this
behind me with the help of my doctor and move on with my life.”

8 ASCO ANSWERS
MANAGING PAIN WITH
MEDICATION
Medication is an option for pain management. There are many different types of
medication that may be recommended based on whether your pain is mild, moderate, or
severe and based on the cause of your pain. In some cases, you may be prescribed more
than one pain medication.

One of the best ways to treat

cancer-related pain is to prevent
pain from developing or getting
worse. When using medication to
treat pain, people usually receive
it at regular, scheduled times. It
is important to take medications
regularly because it maintains a
steady level of medicine in the
body. This is the most effective
way to relieve pain.

Doctors also use “rescue” or extra doses to help control breakthrough pain if it occurs. Your
doctor will look at the amount of medicine used for breakthrough pain at every visit and
adjust your usual dose if needed. Breakthrough pain is pain that suddenly increases, even
though it is being treated.

Types of pain medication

Many different pain-relief medications, called analgesics, are available. Depending on the
drug and a person’s condition, doctors give them in different ways. Some are taken by
mouth, while others are injected into a vein or worn as a skin patch.

Non-opioid pain relievers. These may be options for mild or moderate pain. Doctors
sometimes prescribe them along with other pain medicines for severe pain. These include:
` Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (such as Advil and
Motrin)
` Acetaminophen (such as Tylenol)

MANAGING CANCER-RELATED PAIN 9

Medications commonly used for other conditions. Some medications used for other
health conditions may help relieve pain, particularly nerve pain. These include:
` Some antidepressants, such as duloxetine (Cymbalta)
` Medications to prevent seizures, such as gabapentin (Gralise,Neurontin) and
pregabalin (Lyrica).

Opioids, also called narcotics. These are often taken with non-opioid medications.
Opioids include the following, many of which have multiple brand names:
` Hydrocodone
` Fentanyl
` Hydromorphone (Dilaudid, Exalgo)
` Methadone
` Morphine
` Oxycodone
` Oxymorphone (Opana)
` Tramadol (Conzip)
` Tapentadol (Nucynta)

Medical cannabis (marijuana) or cannabinoids. Several states have approved the use of
cannabis and cannabinoids for chronic pain. Currently, there is not enough evidence for
ASCO to recommend cannabis as an initial option. However, if it is legal in your state, it may
be an option, along with other methods, for unrelieved pain.

10 ASCO ANSWERS
Common concerns about pain medication
Some people with cancer worry about becoming addicted to pain medication. This is a
valid concern, but it is uncommon. Your cancer care team is trained to carefully monitor
people taking pain medication. Your team will also help safely end your pain treatment
when you no longer need it. This may need to be done by slowly decreasing your pain
medication dose over time.

It is also normal for patients to worry about the side effects of medications. Although some
medications, particularly those for moderate or severe pain, can cause side effects such as
constipation, nausea, sleepiness, or confusion or hallucinations, not everyone experiences
them. In addition, all of these side effects can be treated, so it is not necessary for you to
suffer because of them. Discussing any side effects that you are experiencing with your
health care team will usually make it possible to continue using your pain medicine.

If you are concerned about a specific side effect, talk with your doctor about whether it is
manageable or if there are other pain management options. Also, tell your doctor if a side
effect does not go away. Changing the timing, dose, or type of the medication may help.

A NOTE ON OPIOIDS
In recent years, the epidemic of people dying from opioid addiction and overdose
has become a major concern. This has led to national efforts in the United States to
limit opioid prescriptions, including general recommendations from the Center for
Disease Control and Prevention (CDC) on when opioids should be used for chronic
pain. However, the CDC has clarified that these recommendations do not apply to
people receiving cancer care.

Doctors may consider prescribing opioids to some people with cancer when other
options have not worked. There is a risk of abuse by the patient or those close to
him or her. Because of this, doctors will likely ask about these potential risks. It is
very important that patients and caregivers store opioids securely so other people
cannot get them. If someone uses them without a medical reason, serious side
effects and even overdose can happen. If you do not use all of a medication for any
reason, dispose of it in a safe manner. To learn how, read “Storing and Disposing of
Medications” on page 15.

MANAGING CANCER-RELATED PAIN 11

Taking pain medication correctly
A doctor, nurse practitioner, or physician assistant writes a prescription for a specific pain
medication because they feel it will treat your pain in a specific way. Carefully following
the medication instructions will help ensure you get the most benefit from the drug. If
medication is not taken according to the instructions, people often experience more side
effects and the medication is less effective.

With any new pain medication prescription, remember to:

Create a complete list of all the medications you already take. Include all prescription
medications, over-the-counter drugs, and dietary supplements, such as vitamins or
herbal supplements. Share and discuss this list with your health care team, including your
pharmacist, to ensure that all medications remain effective.

Keep taking the medication as prescribed, even if you do not notice an improvement in
your symptoms right away. Many medications take a few weeks to start working. However,
if you feel like the medicine is not working, talk with your doctor.

Keep taking the medication as prescribed, even if you notice an improvement in your
symptoms right away. Ask your doctor how long you should continue to take it.

Contact your doctor if you start to feel worse while taking a medication. Share any new
symptoms you notice.

Talk with your doctor about medication cost concerns that might lead you to lower or
skip a dose. Ask about local and national resources for financial help.

12 ASCO ANSWERS
Keep the information about the medication that comes with your prescription. This
paper describes the drug, its possible side effects, and any potential drug interactions.
Before you start a new medication, go over this information with a member of your health
care team.

You may also want to consider filling all of your prescriptions at the same pharmacy. By
doing this, your pharmacist can keep a complete list of the medications you take and warn
you about possible drug interactions. Drug interactions can happen when a medication
reacts with another medication or supplement you take. This interaction can cause
unexpected side effects, some of which can be very serious, or reduce or increase the
medication’s strength.

QUESTIONS TO ASK ABOUT PAIN MEDICATION

` What is this medication used for?
` How much of the medication will I need to take? How often should I take it?
` How long will I get pain relief from a dose of the medication you are
suggesting?
` How long will it take before I know how effective this medicine will be?
` Is there a certain time of day I should take the medication?
` Do I need to take this medication with food? Or should I take it on an empty
stomach?
` Are there any foods, drinks, supplements, or other drugs that can change the
strength or effectiveness of this medication?
` Can I crush or cut my pills to make them easier to take?
` How long will I need to take this medication? Are there any reasons why I
should stop taking it?
` What should I do if I miss a dose?
` What are the most common side effects of this medication? How can they be
managed?
` What should I do if I experience an unexpected side effect of the medication?
` What follow-up tests will I receive to monitor the medication’s effectiveness?
` If I am worried about managing my medication costs, who can help me?
` If I have questions or problems, who should I call?

MANAGING CANCER-RELATED PAIN 13

Managing multiple prescriptions
You may be prescribed several medications by different health care providers while you
are being treated for cancer. Tracking which medications to take and when, including pain
medications, may seem like an overwhelming task. But there are steps you can take to keep
you on an effective medication schedule. These tips may help:
` Read the entire medication label on each container to make sure you take the right dose
on the right schedule.
` Take your pills at the same time every day, such as first thing in the morning or with
lunch, unless your health care team gives you other directions.
` Use a chart, pill calendar, or your phone’s calendar reminders to set a schedule and track
when you take your medications.
` Use a weekly pill case so you know whether you have taken each day’s medications.
` Ask family members or friends to remind you.
` Ask your doctor what to do if you miss or skip a dose of each medication.
` Ask your pharmacist to use easy-to-read, color-coded labels to make it easier to identify
which medications to take and when.

ASCO’s patient education website, Cancer.Net, also offers a free mobile app that can help
patients and caregivers with keeping medications organized and with questions to ask.
Learn more under the section on “Tracking Pain Using a Mobile Device” on page 22.

14 ASCO ANSWERS
Storing and disposing of medications
Pain medications are very effective at managing and relieving cancer pain, but they are
dangerous if another person or pet accidentally swallows them. It is important to safely and
securely store your prescription pain medication, particularly opioids.

Store your pain medication in a bottle that has a child-resistant lid. You should also keep
all of your opioid medication in a location where no one, not even a pet, can easily see it
or get to it. Do not store your pain medication in many different places around the house
or leave it sitting out. Only share details about your prescription(s) with your caregiver and
others who need to know.

Once your pain treatment is complete, talk with your doctor, nurse, or pharmacist about
how you should safely dispose of leftover pain medication. The U.S. Food and Drug
Administration (FDA) recommends that some opioid medications be flushed down the
toilet. However, some communities have rules and restrictions against this. Another
option is to take any unused or expired drugs to a prescription medication take-back
program collection site. Permanent collection boxes can be found in many communities and
pharmacies. See the “Medication Disposal Resources” box on page 16 to learn more.

Some pharmacies offer packets that are designed to make medications safe for disposal.
With these packets, you insert your medications and add a small amount of water. A
chemical reaction in the packet destroys the medication. You can then seal the packet and
throw it away in the trash.

MANAGING CANCER-RELATED PAIN 15

If you cannot take your medication
to a collection site or flush it, you
may need to put it in the trash. To do
this safely, take these steps:
1. Take all of the medication out
of its container and put it in a
sealable plastic bag or coffee can.
2. Mix the medication with an
undesirable substance, such as cat
litter or used coffee grounds.
3. Seal the container. Be sure to put it
in the trash, not the recycling bin.

If your doctor prescribes a fentanyl skin patch, make sure that used patches are kept away
from others. According to the FDA, too much fentanyl can cause severe breathing problems
and even death in babies, children, pets, and adults. Even after you have used a patch
for several days, there is still fentanyl in the patch, and it can be enough to cause serious
problems for others. After using a patch, fold it in half so the sticky parts are sealed together
and use one of the disposal methods described above.

Ask your doctor what you should do if a pet or family member accidentally comes in contact
with your medication. Some doctors will give you a prescription for a medication called
naloxone, which can be used to rescue someone who is accidentally exposed to opioids.

MEDICATION DISPOSAL RESOURCES

Drug Enforcement Administration Drug Disposal

www.DEATakeBack.com
800-882-9539

MedReturn Drug Collection Unit

www.medreturn.com
877-218-0990

National Association of Boards of Pharmacy: Drug Disposal Locator

www.safe.pharmacy

16 ASCO ANSWERS
OTHER WAYS TO
MANAGE PAIN
Medication often plays an important role in relieving cancer-related pain. There are also
several medication-free self-care and support options you can explore.

These therapies use different techniques and methods to help ease the discomfort of many
physical symptoms. They may also help reduce stress, depression, and anxiety to help you
cope with cancer.

You may find that using more than one self-care or support method helps relieve your pain.
Some people also find that a pain treatment plan that combines some of these methods
with medication works best for them and may let them use less medication to relieve pain.

Self-care methods
Self-care methods are things you can do on your own. In some cases, you may find that
learning certain techniques from a specialist and then continuing them at home may help
you use them more effectively. Talk with your doctor before trying methods that have not
been recommended by your health care team.

Breathing exercises/meditation.
Gentle breathing exercises can decrease
pain. They can also help you relax and
reduce tension. You can do them while
sitting in a chair and relaxing your arms
gently at your side. Or you can do them
while reclining in a chair or lying down
on a bed. Try breathing in through your
nose while you slowly count to 3 in
your head. Then breathe out through
your mouth, once again counting
silently to 3. Continue for 5 minutes
at a time at first, gradually working up
to 20 minutes. You can also meditate.
Meditation exercises may involve softly repeating a calming word. Or you might imagine
breathing heat, coolness, or a feeling of relaxation in and out of painful areas.

MANAGING CANCER-RELATED PAIN 17

Distraction. Certain activities can distract your mind from pain, including:
` Taking a warm bath
` Reading a book
` Watching TV or a movie
` Drawing or painting
` Doing needlework, such as sewing or knitting
` Listening to music
` Taking a short walk outdoors

Heat and cold. Apply hot or cold

compresses, heating pads, or ice packs to
aching, sore, or painful areas of the body.
This will help to decrease discomfort.
Wrap ice packs and compresses in a towel
to protect the skin. And use heating pads
over clothing, a sheet, or a towel. Try
different temperatures to find a method
that provides relief. Talk with your health
care team about this approach. Follow any
special instructions, particularly during or
after radiation therapy or chemotherapy.
Start by applying heat or cold for 5 to 10
minutes at a moderate temperature. Do
not apply heat or cold directly to bare
or injured skin, areas that are numb or
sensitive, and areas that have had recent
radiation therapy.

Imagery and visualization. Many imagery techniques are useful for pain and discomfort
from treatment. For example, with the “magic glove” technique, you imagine putting on a
glove before getting a needle stick in your hand. Then you visualize that the glove protects
your hand from the feeling of pain. Or you may benefit from imagining a peaceful scene,
replaying a favorite memory, or creating a mental picture of healing light taking the pain
away. A trained therapist can teach you different exercises to do on your own.

18 ASCO ANSWERS
Support methods
In addition to methods you can do on your own, there are methods that require you to
work with a licensed or certified specialist.

Acupuncture. This ancient form of Chinese medicine involves inserting special needles into
specific areas of the body. Some research has shown that it can relieve cancer-related pain.
Make sure to see an experienced practitioner who only uses sterile needles.

Biofeedback. This technique helps you control your body’s functions, such as your heart
rate. Painless sensors are placed on your skin to gather information about the body’s
processes. A trained biofeedback therapist uses this information to help you focus on
making small changes to your body. These changes may include relaxing certain muscles to
reduce pain.

Counseling and support groups. Talk

with a trained counselor or attend a
cancer support group. This will help
you to learn about pain management
techniques that have worked for others.
Getting this support may also relieve
some physical and emotional tension
that often makes pain worse.

Massage. A massage therapist who has experience working with people with cancer can
provide gentle therapeutic massage. This may help relieve tension, discomfort, and pain. A
caregiver can do simple massage techniques at home, including gentle, smooth, circular
rubbing of the feet, hands, or back. You can also massage yourself by applying light, even
pressure to your hands, arms, neck, and forehead.

Nutritional support. Cancer and cancer treatments sometimes cause mouth sores or
nausea. These side effects make it hard to maintain proper nutrition. Not getting enough
nutrients from food can cause pain or discomfort. A dietitian (a food and nutrition
professional) or your doctor may recommend that you take supplements or change your
diet to reduce these side effects.

MANAGING CANCER-RELATED PAIN 19

Physical therapy or occupational therapy. A physical therapist treats nerve, muscle, and
fitness problems that make it difficult for a person to function well on a daily basis. He
or she can teach you how to relieve pain using simple exercises or devices. This includes
artificial body parts, splints, or braces.

An occupational therapist helps people prevent and live with illness, injury, and disability.
For example, an occupational therapist may help someone avoid lymphedema after
cancer surgery. Lymphedema is a painful buildup of fluid caused when lymph nodes are
removed. You may also want to see a certified lymphedema therapist (CLT). A CLT is a health
professional who specializes in managing lymphedema.

Integrative medicine is a combination of medical treatments for cancer and

complementary therapies to cope with symptoms and side effects, such as pain. It
includes treatments like acupuncture, massage, physical therapy, and more. For more
information about integrative medicine, visit www.cancer.net/integrative.

20 ASCO ANSWERS
COMMUNICATING WITH
YOUR HEALTH CARE TEAM
Once your doctor diagnoses your
pain and you have started your pain
management plan, maintaining open and
honest communication is a very important
part of your care. Research shows that
people who have good communication
with their doctor tend to be more satisfied
with the care they receive.

The most important thing you can do to manage your pain is to keep the members of
your health care team informed about how treatment is working. Tell a member of the
health care team if your pain is not being relieved. The doctor can help figure out why it is
not working and find an option that works better for you.

The type, intensity, and location of pain is different for everyone. But consistent teamwork
between you and your health care team can help you find an effective solution.

BARBARA’S STORY
Barbara is a 55-year-old working mother of three and an avid runner. After a
routine chest x-ray, followed by additional tests, she was diagnosed with lung
cancer. She told her doctors and nurses that she was very worried about the
side effects of chemotherapy. It was important to Barbara to try to maintain as
much of a normal routine as possible, despite her aggressive cancer treatment
plan. When she started experiencing joint and muscle pain, Barbara shared her
symptoms with her doctor. Her pain started the moment she got out of bed
each morning and continued throughout the day. She worried that she might
not be able to finish chemotherapy. She also worried that the pain was due to
her cancer, rather than a side effect of her treatment. Barbara’s doctor assured
her that her pain was treatment-related and that there were ways to manage
her discomfort. “My doctor alleviated my fears and we found a medication that
worked for me. I was not able to run during my treatment, but I managed to
finish my chemotherapy. Plus, I was able to keep up with my busy family.”

MANAGING CANCER-RELATED PAIN 21

How pain tracking helps
Track the results of your pain management techniques to find out which ones work best
for you. You can do this by using a pain chart, pain log, or pain diary. Tracking your pain,
even for a few days, sometimes can reveal patterns in the pain that can be used to improve
pain control.

Helpful information to track includes:

` The date and time you experience the
pain and how long it lasted.
` What activities you were doing when the
pain started.
` Where in your body the pain started and
if it was specific to one area or moved to
other parts of the body.
` The intensity of the pain from 0 to 10, with
10 being the highest level of pain.
` How the pain felt, such as burning, stabbing, aching, or throbbing.
` The pain control methods you tried and how effectively they worked. Include any
methods you are using that might not have been prescribed or recommended by your
health care team.
` Information about pain caused by other health conditions you may have, such as
diabetes or arthritis.

There is a sample pain tracking chart on pages 26 and 27 of this booklet. You can
also make your own paper chart or ask your doctor for a chart. Another option is to search
the internet for “pain management chart” or “pain tracking chart” and several options will
appear. You can save the chart you prefer to your computer and print it out.

TRACKING PAIN USING A MOBILE DEVICE

Cancer.Net Mobile, a free app for iOS (iPhone, iPad) and Android, features a symptom
tracker that allows you to record the time and severity of symptoms and side effects,
such as pain. An interactive tool also lets you keep track of your questions to ask
health care providers and record voice answers. In addition, there’s a place to save
information about prescription medications. To learn more about Cancer.Net Mobile,
visit www.cancer.net/app.

22 ASCO ANSWERS
RESOURCES
You can find additional information about pain management and links to patient support
and resource organizations on Cancer.Net (www.cancer.net). The following national
organizations also provide resources about the topics addressed in this booklet.

American Academy of Hospice and Center to Advance Palliative Care

Palliative Medicine www.getpalliativecare.org
www.palliativedoctors.org
International Association for Hospice &
American Cancer Society Palliative Care
www.cancer.org www.hospicecare.com
800-227-2345 866-374-2472

CancerCare National Cancer Institute

www.cancercare.org www.cancer.gov
800-813-4673 800-422-6237

Cancer Support Community National Hospice and Palliative Care

www.cancersupportcommunity.org Organization
888-793-9355 www.caringinfo.org
703-837-1500
Caregiver Action Network
www.caregiveraction.org
202-454-3970

Programs and services continually change, so visit www.cancer.net/support to find

the most current information.

LOCAL RESOURCES

MANAGING CANCER-RELATED PAIN 23

DICTIONARY
Acupuncture: The use of very tiny needles and pressure to stimulate points on the body.

Addiction: A chronic disease characterized by seeking out drugs and using them that is
difficult to control even though a person knows that the behavior can harm them.

Analgesics: Medications that relieve pain.

Antidepressants: Medications that treat depression.

Biofeedback: A method in which painless sensors are placed on a person’s skin to gather
information about the body’s processes.

Breakthrough pain: Pain that increases suddenly even though it is being treated.

Chemotherapy: The use of drugs to destroy cancer cells.

Dose: The amount of a medication that a person should take at one time.

Drug interactions: Unexpected side effects that occur when a medication reacts with
another medication.

Hormonal therapy: Treatment that removes, blocks, or adds hormones to destroy or slow
the growth of cancer cells. Also called hormone therapy or endocrine therapy.

Integrative medicine: A combination of medical treatments to treat cancer and

complementary therapies to manage the patient’s symptoms and side effects.

Lymphedema: A painful buildup of fluid caused when lymph nodes are removed.
Lymphedema causes swelling, often in an arm or a leg.

Medical cannabis: Marijuana that is approved for medical use.

Medication take-back program: A program that collects unused or expired prescription

medicines.

Meditation: A way for a person to learn to focus attention to calm the mind and relax
the body.

Non-opioid pain relievers: Pain relievers such as non-steroidal anti-inflammatory drugs

(ibuprofen and others) and acetaminophen that are prescribed for mild or moderate pain.

24 ASCO ANSWERS
Oncologist: A doctor who treats cancer.

Opioid pain relievers: Pain relievers used to treat moderate to severe pain that work by
attaching to specific proteins called opioid receptors. Also called narcotics.

Over-the-counter drugs: Medications that you can buy without a prescription from a
health care provider.

Pain assessment: A way for the health care team to determine a person’s level of pain and
to help guide decisions about how to treat it. There are a number of tools used to do a pain
assessment. The assessment may measure the pain’s frequency, severity, location, causes,
and more.

Pain management plan: A personalized plan that the doctor recommends to help relieve
pain.

Pain tracking log: A chart or journal that a person uses to track pain and the results of pain
management techniques.

Pharmacist: A health care professional who dispenses medications.

Quality of life: An overall sense of well-being and the level of satisfaction with life.

Radiation therapy: The use of high-energy x-rays or other particles to destroy cancer cells.

Rescue doses: Extra doses of pain medicine prescribed by a doctor to control

breakthrough pain.

Side effect: An undesirable result of treatment, such as pain, fatigue, nausea, vomiting,or
hair loss.

Stem cell/bone marrow transplant: A type of cancer treatment in which a patient receives
new stem cells to replace the body's bone marrow.

Supportive care: Any form of treatment that concentrates on reducing a patient’s

symptoms or treatment-related side effects, improving quality of life, and supporting
patients and their families. Also called palliative care or symptom management.

Surgery: The removal of cancerous tissue from the body through an operation.

Tumor: A mass that forms when healthy cells change and grow out of control. A tumor can
be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other
parts of the body. A benign tumor means the tumor can grow but will not spread.

MANAGING CANCER-RELATED PAIN 25

SAMPLE PAIN TRACKER
PAIN SCALE CHART
Use the pain scale chart to determine your pain score below.

How does the pain feel?

Date Time Pain score (aching, sharp, shooting,
throbbing, etc.)

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

0 1 2 3 4 5 6 7 8 9 10

26 ASCO ANSWERS
 Put an X on the parts of Front Back
your body where you feel
pain and the time when the
pain happened.

What were you doing What did you do to How long did
when the pain started? relieve the pain? the pain last?

MANAGING CANCER-RELATED PAIN 27

NOTES

28 ASCO ANSWERS
Looking for Other Patient Information
Resources?
ASCO ANSWERS GUIDES
ASCO Answers Guides feature comprehensive information about the diagnosis,
treatment, side efects, and psychosocial efects of a specifc cancer type, as well
as practical information for patients and families. Guides on survivorship and
caregiving are also available.

ASCO ANSWERS FACT SHEETS

ASCO Answers Fact Sheets provide a one-page (front and back) introduction
to a specifc type of cancer or cancer-related topic. Each includes an overview,
illustration, words to know, and questions to ask the health care team.
Cancer.Net has more than 65 fact sheets available (including some in Spanish),
covering diferent cancer types, diagnosis and treatment, and side efects.

ASCO ANSWERS BOOKLETS

ASCO Answers Booklets provide in-depth, practical guidance on specifc topics in
cancer care, including advanced cancer care planning, pain, cost of care, managing
weight, palliative care, and stopping tobacco use.

For Patients and Caregivers: If you are interested in additional educational

materials, visit www.cancer.net/ascoanswers to fnd all of our available materials in
electronic format.

For Oncology Professionals: Bulk quantities of high-quality print materials are

available for purchase. Visit www.cancer.net/estore or call 1-888-273-3508 to place
your order.

To request free promotional materials for your practice, please send an email to
contactus@cancer.net.

WE WANT TO HEAR FROM YOU

If you found this material helpful or if you have comments or suggestions about
how it could be better, please let us know at contactus@cancer.net.
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